This is a community based multi-risk factor intervention in a geographically defined area of Baltimore designed to improve birth outcome, especially to reduce the rate of low birth weight in the target population. The initiative for this project has come from the Baltimore City Health Department. The Baltimore City Health Department, in turn, has requested technical assistance by the staff of DESPR in the design of the intervention and the evaluation of its impact upon the target population. This is a quasi-experimental design which will compare outcome measures which are available from vital records information for birth in the target area during the period of the project with outcome measures derived from other areas of Baltimore which are similar in population characteristics. In addition there will be a process evaluation which will address smoking, drinking and drug abuse as well as compliance with prenatal care and also knowledge and attitudes about appropriate health behaviors during pregnancy. Patients have been enrolled in this project since December 1, 1990 and approximately 500 have been enrolled thus far. This project has become the starting point and nucleus for the Healthy Start Initiative in Baltimore which is funding by HRSA. As a result of this development, this project has been terminated and the analysis of the data are in progress.